The New International, January 1939

William Harvey

Socialized Medicine

I AM GRATEFUL to Mr. Rorty both for his kind remarks and for his helpful supplementary information. (a) The significance of “socializing losses” is highly important. The lack of adequate workers’ (or other consumers’) representation on control boards is one of the most conspicuous shortcomings of nearly all the hospitalization schemes now in operation in this country, (b) Since my article was written, several State and County medical societies have proposed “insurance plans” of their own in an attempt to forestall truly cooperative medical care plans. These are, as Mr. Rorty points out, without exception entirely devoid of any real benefit to the subscribers. In general, “cash indemnity” plans are wasteful and serve only as smoke-screens to hide their bad features. Similar plans are about to be proposed in New York, West Virginia, and Ohio, among other places. They all have high initial payments, marked restrictions on service, and numerous exceptions which make them prohibitively expensive and virtually useless. We should make every effort to educate workers to avoid participation in any such plans. (c) I am particularly glad that the position of the drug houses was mentioned. It should be clearly understood that these companies are working hand in glove with the hierarchy of the AMA to prevent any real progress in reducing the swollen profits that the organized medical profession has been making at the expense of the workers.

In reply to Dr. Mia, I should like to point out at once that although he speaks of the facts as “not quite accurate” he does not mention a single specific example of inaccuracy.

(a) It is quite true that the medical “Bourbons” fear government control. Their fear of it, however, is that it would tend to reduce their opportunities to charge large fees with no supervision. This is of course a reactionary opposition. My position with regard to government control, on the other hand, is based on the Marxian analysis of die class nature of the State. There are two closely allied reasons why working-class leaders should oppose government control of medical care: in the first place, it would mean that the owning class through their State would be directing the medical services for which, in the final analysis, the workers are themselves paying. No real advance for the workers in standards of care or in wider distribution of benefits can be effected under such auspices. Furthermore, in any clash between the working class and the bourgeoisie, the State-controlled medical services would without question take sides against the workers. This has been illustrated again and again both in Europe and this country.

In the second place, as I pointed out in my article, government control will serve to increase the workers’ dependence upon bourgeois State paternalism. Leaders who wish to aid in the development of true class-consciousness among workers will therefore do better to stimulate independent working class health organizations as one means of promoting class-consciousness. Such organizations should, of course, as I originally pointed out, obtain all possible funds from governmental sources, but at the same time retain essential control for themselves. This attitude constitutes a progressive opposition to government control.

(b) Dr. Mia has mistaken the purpose of my emphasis on group medicine. I have no more desire than he to see over-specialization in medical work. A certain degree of specialization is necessary in modern medicine, however, and the object of group medical practise is to make intelligent, integrated, economically sensible use of the various specialities without losing sight of the importance of general knowledge. I would even go so far as to suggest that ideally every specialist in a group clinic would spend a certain proportion of his time working as a general diagnostician.

(c) I am glad that Dr Mia also emphasizes the significance of “socializing losses” – a point mentioned in my article but not fully developed there, as both he and Mr. Rorty have kindly pointed out.